Individual
DR. STEPHEN J TIDIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
77 CASA ST, SUITE 103, SAN LUIS OBISPO, CA 93405-5803
(805) 544-8993
(805) 544-0120
Mailing address
77 CASA ST, SUITE 103, SAN LUIS OBISPO, CA 93405-5803
(805) 544-8993
(805) 544-0120
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G57086
CA
208600000X
Surgery Physician
Primary
G57086
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G570860
—
CA
01
—
G57086
MEDICAL LICENSE
CA
Enumeration date
09/19/2005
Last updated
06/17/2008
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